key: cord-0825372-cqq7cprj
authors: Singh, Priya; Singh, Surya Pratap; Verma, Amit Kumar; Raju, Sreenivasa Narayana; Parihar, Anit
title: A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients
date: 2021-08-26
journal: Visc Med
DOI: 10.1159/000518473
sha: 320c903288f5815e7d3a2b7b7380298e77b86955
doc_id: 825372
cord_uid: cqq7cprj

OBJECTIVE: The objective of this systematic review was to evaluate key imaging manifestations of COVID-19 on abdominal imaging by utilizing a comprehensive review of the published literature. METHOD: A systematic literature search from PubMed, Google Scholar, and Scopus was performed for studies mentioning abdominal imaging findings in COVID-19 patients. Studies published from inception to 15 March 2021 were included. RESULTS: A total of 116 studies comprising 1,198 patients were included. Abdominal pain was the most common indication for abdominal imaging in 50.2% of the patients. No abnormality was seen in 48.1% of abdominopelvic computed tomography scans. Segmental bowel wall thickening (14.7%) was the most common imaging abnormality, followed by bowel ischemia (7.1%), solid organ infarction (6.7%), vessel thrombosis (6.7%), and fluid-filled colon (6.2%). Other relevant findings were dilated air-filled bowel, pancreatitis, pneumatosis/portal venous gas, bowel perforation, and appendicitis. Other than abdominal findings, COVID-19-related basal lung changes were incidentally detected in many studies. Moreover, the presence of bowel imaging findings was positively correlated with the clinical severity of COVID-19 infection. CONCLUSION: This review describes the abdominal imaging findings in COVID-19 patients. This is pertinent for the early diagnosis of COVID-19 in patients presenting solely with abdominal symptoms as well as in identifying abdominal complications in a known case of COVID-19.

In December 2019, there was an emergence of a cluster of an unidentified type of viral pneumonia in Wuhan city located in the Hubei province of China. The causative agent of this disease was later identified as a novel coronavirus which has 80% similarity with severe acute respiratory syndrome coronavirus (SARS-CoV) detected in 2013. This respiratory disease rapidly spread to other parts of China and then crossed international borders to spread in different parts of the world over a short period. The disease was later named COVID-19, and the causative virus was given the name SARS-CoV-2. On 11 March 2020, WHO declared it as a pandemic and CO-VID-19 emerged as a global health emergency. As of 2 May 2021, there were over 151 million cases of coronavirus worldwide with more than 3 million deaths reported globally [1] .

The majority of patients of COVID-19 presented with fever and respiratory illness. But studies have shown that extrapulmonary symptoms like gastrointestinal (GI), neurological, cardiac, and renal symptoms are not uncommon in COVID-19 cases [2] . Amongst these, CO-VID-19 has a very high prevalence of GI symptoms. About 12% of COVID-19 patients reported GI symptoms during their course of illness, while fecal shedding was present in 41% of patients [3] . In another study on COVID-19, GI symptoms were as high as 50% which include symptoms like nausea (17.3%), diarrhea (12.9%), anorexia (12.2%), abdominal pain (5.8%), belching (5%), and emesis (5%) [4] . Abdominal and GI symptoms can also be the initial presentation of COVID-19 infection. DOI In such cases, there is more likelihood of missing the diagnosis. Radiological imaging may help in identifying some common imaging features which are more frequently seen or characteristic for COVID-19 patients. Thus, imaging can give a clue toward the possibility of COVID-19 infection in patients with abdominal symptoms. There are many studies in the current literature on the GI and abdominal symptoms in COVID-19 but very few of them have described the imaging findings in such cases. Despite limited available data, clinicians, especially radiologists must be aware of the common abdominal imaging findings in COVID-19 patients who present with abdominal symptoms. This systemic review will help in the early identification of COVID-19 patients with abdominal symptoms and predict the prognosis of the disease. 

All the studies that mentioned abdominal imaging findings in patients having COVID-19 infection were selected. Only those patients were included in whom COVID-19 infection was confirmed on the RTPCR/antigen test either before or after the imaging. Those articles in which imaging findings were not described were excluded. No restriction on the language of the studies was kept. Only fully extractable studies were selected. Titles, keywords, abstract, or body of the manuscript was screened independently by 2 reviewers to shortlist the final articles according to the abovementioned criteria. All the duplicate studies were excluded. Disagreements were resolved by discussion and consensus between the reviewers. Search strategy and study selection (shown in Fig. 1 ) were done as described in the PRISMA statement [5] . The study was registered in the PRISMA trial -PROSPERO (CRD42020203384) [6] . Data Extraction and Quality Assessment Data extraction was done by authors independently. An excel sheet database was maintained under different variables which include the study design, country, sample size, indication of imaging, imaging methods, imaging finding, normal imaging findings, clinical severity, and any important notes of cases. Finally, a narrative synthesis of the data was done using a Microsoft Excel sheet without meta-analysis. Additionally, a comparison between clinical severity and the presence of specific imaging findings was done, subject to the availability of clinical details in the studies. The methodology quality of studies was rated fair based on 9 items featured in the National Institute of Health quality assessment tool for case series studies [7] .

A total of 4,452 articles were identified after an extensive search of the literature on all three databases and the removal of duplicates. Titles/abstracts of these articles were manually screened and finally 342 articles qualified for full-text review. After further scrutiny, a total of 116 articles in which abdominal imaging were done and met the inclusion criteria were included in the systematic review. Details of these studies are shown in Table 1 . Out of 116 studies included, 15 were retrospective studies with a sample size of 10 or more, 37 were case series (having less than 10 cases), and 64 were case reports. There is a scarcity of reporting of abdominal imaging findings in COVID-19 in the present literature due to which sample size in most of the included studies was small except in 7 studies where the sample size was >50. In these 116 studies, there were a total of 1,198 patients with 176 abdominal X-rays, 172 abdominal ultrasonography, 949 abdominal computed tomography (CT)scans, and 6 magnetic resonance imaging done. Out of 1,198 patients, 72 were pediatric patients and 1,126 adults. Correlation of the presence of bowel imaging findings with clinical severity was done in 7 studies having a total of 473 adult patients.

The most common abdominal symptom for which abdominal imaging was done in COVID-19 patients was abdominal pain (50.2%; 350 out of 697 patients) either alone or associated with other symptoms. Nausea and/or vomiting (26%; 186 out of 697 patients) and diarrhea (25%; 176 out of 697 patients) were among the other common symptoms. Imaging was done for suspicion of abdominal infection or sepsis in 40 patients (5.7%) and abdominal bloating or distension in 39 patients (5.5%). Other uncommon indications were GI bleed (21 patients; 3%), bloody diarrhea (13 patients; 1%), scrotal pain (3 patients), and oliguria (3 patients). Deranged liver function tests or raised amylase, lipase, or lactate were imaging indications in few studies. Eight patients were having acute ischemia of lower limbs for which abdominal and lower limb imaging were done. In most of the patients, abdominal symptoms were initial complaints, and in some, only presenting symptoms of COVID-19. While in the rest of the patients it developed subsequently during illness. Among pediatric patients, abdominal pain, vomiting, and diarrhea were common indications for abdominal imaging. Bloody diarrhea was seen in 7 pediatric patients.

In 501 (41.8%) patients, indication for abdominal imaging was not described. In 2 retrospective studies by O'Shea et al. [8] and Dane et al. [9] , abdominal imaging demonstrating the presence of thrombosis and ischemia was only included. In both these studies, indications for imaging were not described. A recent study by Tirumani et al. [10] compared abdominal imaging findings of CO-VID-19 in 34 patients who were not having any abdominal symptoms to 38 patients who were having abdominal symptoms. They found that two-thirds (61.5%) of patients having bowel imaging findings were not having any abdominal symptoms. Also, abdominal findings were incidentally detected in upper abdominal cuts of chest CT in 5 patients of 3 different studies [10] [11] [12] .

A total of 26 studies reported no concerning abnormality on abdominal imaging in 577 (48.1%) patients (563 adults and 14 pediatric). Thus, 563 adults and 58 pediatric patients were having positive imaging studies. Among imaging studies, 154 (87.5%) of abdominal Xrays, 73 (42%) of ultrasonography, 437 (46%) of abdominal CT, and 3 (50%) of magnetic resonance imaging were normal. Of patients, 43%, 64%, and 76% in 3 different large retrospective studies, respectively, have no abnormal abdominal imaging findings [13] [14] [15] . Another study by Tirumani et al. [10] showed that among 59 patients having normal imaging findings, 18 (31%) patients were having abdominal symptoms. Additionally, many case series have shown the importance of lung base findings in detecting COVID-19 in otherwise normal abdominal scans [14] [15] [16] [17] [18] [19] [20] [21] [22] 30] .

Bowel Involvement Among all the reviewed studies, the bowel was the most commonly involved organ, and bowel wall thickening with or without local inflammation was the most common imaging finding (83 patients; 14.7%; shown in Table 2 ). Out of these, large bowel was involved in 28, small bowel in 26, stomach in 6, esophagus in 2, and the site was not mentioned in 23 patients.

Intestinal ischemia (40 patients; 7.1%) was the second most common imaging finding. Imaging findings de-DOI: 10.1159/000518473 scribed in intestinal ischemia on CT scan were bowel wall thickening or thinning, hyperenhancement or severe hypoenhancement-associated mesenteric intravenous air, bowel wall air, free air in the peritoneum, and portal venous gas. An associated mesenteric vein thrombus (3 patients) and superior mesenteric artery thrombus (3 patients) were also present in a few of them. A fluid-filled bowel or colon was the third common (35 patients; 6.2%) imaging manifestation. Dilated air-filled bowel was seen in 33 patients (5.8%) and perforation with pneumoperitoneum in 9 patients (1.6%). Pneumatosis of the bowel wall was seen in 25 patients (4.4%) associated with portal venous gas in some of them. Three patients had associated bowel wall thickening. Acute appendicitis and GI bleed were seen in 7 patients (1.2%) and 6 patients (1%), respectively. Few other uncommon findings were colonic diverticulosis (7 patients; 1.2%), mesenteric or peri-intestinal stranding (4 patients; 0.7%), and epiploic appendicitis (1 patient; 0.1%).

We also studied the association between the presence of bowel abnormalities on imaging with the frequency of ICU admission, intubation, death, and length of hospitalization or ICU stay. Due to heterogeneity of data and lack of clinical details, only 7 studies (total 473 patients) qualified for this comparison, and most of the case reports and case series were excluded. The presence of bowel findings on imaging studies was positively correlated with clinical severity, indirectly assessed by ICU admission (66 vs. 34%), intubation (36 vs. 19%), death (26 vs. 14%), and length of hospitalization (17.3 vs. 14.6 days) or ICU stay (10.8 vs. 7.3 days; shown in Table 3 ).

Infarction was the most common imaging finding in solid visceral organs. Out of the total of 38 patients (6.7%) with solid organ infarcts, the spleen was the most commonly involved (17 patients), followed by either of the kidneys (16 patients). For the other 5 infarcts, an organ is not specified.

Imaging findings of acute pancreatitis were seen in 29 patients (5.1%). Out of these, 3 patients also had main pancreatic duct dilatation.

Other less common imaging findings (6.3%) included hepatomegaly (4 patients), pyelonephritis (11 patients), nonspecific renal stranding (8 patients), splenomegaly (2 patients), hepatitis (2 patients), echogenic kidneys (3 patients), heterogenous liver (2 patients), and enlarged kidneys (2 patients). Bilateral adrenal involvement was seen as infarction and hemorrhage, 1 patient of each (2 patients).

Vascular Thrombosis Vascular thrombosis including both arterial and venous thrombi was diagnosed in a total of 38 patients (6.7%). Acute thrombus in the abdominal aorta was seen on CT in 15 patients. Two of these patients had associated splenic artery thrombosis with splenic infarction, and another patient had a thrombus in the renal artery. Thrombus extension into the celiac and internal iliac artery was also seen, one case of each. Superior mesenteric artery thrombus was seen in 8 patients and isolated internal iliac artery thrombus in 1. There was one case report (1 patient; 0.2%) describing infrarenal aortitis with focal dissection [69] . Venous thrombosis was seen involving superior mesenteric vein (4 patients), portal vein (4 patients), inferior mesenteric vein (1 patient), renal vein (2 patients), inferior vena cava (2 patients), and ovarian vein in pregnant women (1 patient).

Gall Bladder and Biliary System Gall bladder sludge (24 patients on ultrasound; 4.2%) was the most common imaging finding in COVID-19 pa- Other Nonspecific Imaging Findings Nonspecific findings detected on abdominal imaging (12%) include urinary bladder thickening/cystitis (36 patients), ascites (15 patients), retroperitoneal lymphadenopathy (4 patients), mesenteric lymphadenopathy (4 patients), retroperitoneal hematoma (1 patient), infiltration of retroperitoneal fat (3 patients), epididymitis (1 patient), adnexal torsion (2 patients), and hydrosalpinx (2 patients). These findings were likely incidental and not directly related to COVID-19 infection.

Abdominal Imaging Findings in Pediatric Patients Among pediatric patients (72 patients), inflammatory bowel wall thickening (20 patients; 34%) was the most common finding, predominantly involving the ileum and ileocecal region (12 patients). Mesenteric lymphadenopathy (13 patients; 22%), ascites (13 patients; 22%), and signs of acalculous cholecystitis like gall bladder edema, biliary dilatation, and biliary sludge (10 patients; 17.2%) were also seen in a subset of COVID-19 patients. Other less common imaging findings included intussusception (7 patients), hepatomegaly (6 patients), echogenic kidneys (5 patients), dilated bowel (5 patients), appendicitis (2 patients), acute pancreatitis (2 patients), pneumatosis (2 patients), splenomegaly (1 patient), and orchi-epididymitis (1 patient) [107] [108] [109] [110] [111] [112] [113] [114] [115] [116] [117] [118] [119] [120] [121] [122] [123] . Bowel wall thickening and ascites were the most common imaging findings in pediatric patients having multiple inflammatory syndromes [107] [108] [109] .

SARS-CoV-2 virus invades the alveolar epithelial cells by binding to angiotensin-converting enzyme 2 (ACE 2) receptors [124] . These receptors are also found on enterocytes, vascular endothelial cells, the pancreas, kidneys, adrenals, biliary tree, and testis. Such ACE-2 receptors may be responsible for the direct entry of this virus into these organs leading to local pathological reaction and therefore abnormal imaging findings. This is supported by the detection of the SARS-CoV-2 virus in feces samples and samples from a pancreatic pseudocyst [29, 89, 125] . One case report also mentioned the presence of viral RNA in the gallbladder wall in a patient with acute acalculous cholecystitis [96] . Marked pro-inflammatory response in COVID-19 infection causes the release of cytokines with activation of the coagulation cascade [126, 127] . This leads to a prothrombotic state with an increased risk of thrombus formation at multiple sites. These serial changes explain vascular thrombosis, bowel ischemia, and solid organ infarction.

This review describes the key abdominal imaging features in COVID-19 after compiling the data from the published literature. The data demonstrated abdominal pain to be the most common indication for abdominal imaging, accounting for the majority of CT scans. Around 48.1% of abdominopelvic CT scans were normal with no reported abnormalities. Therefore, negative abdominal scans are not uncommon in COVID-19 patients. However, in COVID-19 patients who present only with abdominal symptoms, these scans may incidentally detect changes of SARS-CoV-2 pneumonia at the lung bases as a hint of this infection [14] [15] [16] [17] [18] [19] [20] [21] [22] 30] .

As per the review, bowel involvement was most frequently detected on abdominal imaging in COVID-19 Tirumani et al. [10] (N) Horvat et al. [106] (N) Bhayana et al. [33] (N) Goldberg-Stein et al. [13] (N) Abdelmohsen et al. [44] (N) Wong et al. [103] (N) Norsa et al. [50] patients with segmental wall thickening commonest reported finding. This is in agreement with 2 large retrospective studies by Funt et al. [15] and Bhayana et al. [33] , where bowel wall thickening was the predominant finding seen in 28.8% and 31% patients, respectively. Intestinal ischemia was the second most common finding as described in multiple case reports. Many studies have demonstrated intestinal pneumatosis and proposed ischemia to be the cause [33, 37, [102] [103] [104] [105] . Although fluid-filled bowel was the most common bowel imaging finding in 2 large studies by Tirumani et al. [10] and Bhayana et al. [33] , in our review it was the third most common bowel imaging finding. The possible reason for such difference could be underreporting of this finding. After pooled analysis, frequency of ICU admission, intubation, death, and length of hospitalization/ICU admission were positively correlated with the presence of bowel abnormalities in this study. The presence of bowel involvement was also positively correlated with ICU admission in a study by Bhayana et al. [33] However, no such correlation was obtained in the study by Tirumani et al. [10] , where they explained that systemic hypoperfusion and systemic coagulopathy seen in ICU patients, unrelated to the direct effect of covid infection could be the cause of ischemic and bowel-related changes seen on imaging. Although, a recent study with a sample size of 486 patients found a higher rate of GI complications, including mesenteric ischemia, in critically ill patients with CO-VID-19 compared with propensity score-matched patients without COVID-19 [128] . These findings suggest that there is a higher risk of bowel abnormalities in critically ill patients and those with bowel findings on imaging have a higher chance of poor prognosis and increased clinical severity.

After GI tract abnormality, solid visceral organ infarction and vessel thrombosis were the second most common abnormality. Multiple case reports and few large case series demonstrated thrombus in major abdominal arteries and veins confirming the presence of hypercoagulability in COVID-19 infection [8, 9] . Acute pancreatitis was a common imaging finding in COVID-19 infection both in the adult and adolescent age-groups. Gall bladder and biliary findings were also reported, mostly on ultrasound. Apart from inflammatory bowel wall thickening, mesenteric lymphadenopathy and ascites were commonly reported in the pediatric age-group.

A study by Barkmeier et al. [14] , which evaluated 43 abdominal CT concluded that positive abdominal findings in their study were not different from their pre-pandemic abdominal findings evaluated for abdominal pain, and the role of abdominal CT in COVID-19 was only to identify characteristic pulmonary findings if present at the lung bases. In contrast, another study by Funt et al. [15] which compared abdominal imaging findings of 338 COVID-19 positive patients with that of 259 COVID-19 negative patients. They found out that abdominal pathology was less frequent in COVID-19 positive patients as compared to negative patients (70.1 vs. 52.2%); however, when abdominal findings were present, COVID-19 positive patients had a higher rate of imaging findings suggestive of inflammation of organs with high expression of ACE-2 receptor (58 vs. 29.8%) [15] . Therefore, the causal relationship between COVID-19 infection and occurrence of abdominal imaging findings has not been fully established and needs further research. Our study determines the correlation between COVID-19 and organ involvement of disease; however, the extent to which factors like comorbidities, the severity of illness, and treatment administered influence the imaging findings were not determined.

Our review highlights the common imaging findings in the abdomen of COVID-19 patients. The presence of these common imaging findings should alarm the radiologist and clinicians to raise the possibility of COVID-19 infection or its complications. The presence of imaging findings, especially bowel abnormalities predict poorer prognosis and increased clinical severity of COVID-19 infection. Thus, imaging should not be delayed in CO-VID-19 patients presenting with abdominal symptoms. The presence of bowel ischemia, solid organ infarction, and other thromboembolic phenomena on imaging can guide in making important clinical decisions regarding anticoagulation treatment or catheter-directed thrombolysis.

Like others, this review also has some limitations. Due to the broad scope of this review, some of the imaging features may have been missed. Few relevant studies might have been missed due to the nonutilization of other search databases. The experience and expertise of different interpreting radiologists in studies may induce variability in imaging findings. Studies were heterogeneous in terms of sample size, inclusion, exclusion criteria, and methodology, which may introduce variability in imaging findings among studies. Additionally, due to the lack of comparison groups in most studies, findings on imaging, especially fewer common ones can be coincidental and not related to COVID-19. The severity of the disease, treatment administered, and time at which imaging was done are the factors that may influence the imaging findings. These factors were not considered in our study.

GI tract abnormality is the most common imaging finding on abdominal imaging. Nonspecific segmental bowel wall thickening, followed by ischemic bowel chang-Visc Med DOI: 10.1159/000518473 es and fluid-filled colon were the predominant bowel changes. Solid organ infarction, vascular thrombosis, and pancreatitis were not uncommon in patients of CO-VID-19. The presence of bowel abnormality on imaging was associated with increased clinical severity and poor prognosis of disease. Knowledge of these imaging features will help in considering a diagnosis of COVID-19, identifying its complications, and predicting clinical severity in an appropriate clinical setting.

World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Available from

Extrapulmonary manifestations of COVID-19

Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with coronavirus disease 2019: a systematic review and meta-analysis

Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan

PROSPERO: a registry for systematic review protocols

Study quality assessment tools

Multisystem assessment of the imaging manifestations of coagulopathy in hospitalized patients

Hypercoagulability in patients with coronavirus disease (COVID-19): identification of arterial and venous thromboembolism in the abdomen, pelvis, and lower extremities

Are asymptomatic gastrointestinal findings on imaging more common in COVID-19 infection? Study to determine frequency of abdominal findings of COVID-19 infection in patients with and without abdominal symptoms and in patients with chest-only CT scans

Pneumatosis intestinalis in COVID-19

Concomitant acute aortic thrombosis and pulmonary embolism complicating COV-ID-19 pneumonia

Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19)

Abdominal CT in COVID-19 patients: incidence, indications, and findings

Abdominal pelvic CT findings compared between COVID-19 positive and CO-VID-19 negative patients in the emergency department setting

COVID-19 pneumonia identified by CT of the abdomen: a report of three emergency patients presenting with abdominal pain

Unexpected findings of coronavirus disease (COVID-19) at the lung bases on abdominopelvic CT

Three unsuspected CT diagnoses of COVID-19

Covid-19 med akutte magesmerter som debutsymptom. Tidsskrift Den Norske Legeforening

Lung base findings of coronavirus disease (COVID-19) on abdominal CT in patients with predominant gastrointestinal symptoms

COVID-19 patients presenting with afebrile acute abdominal pain

Can COVID 19 present like appendicitis? IDCases

Suspected acute abdomen as an extrapulmonary manifestation of Covid-19 infection

Abdelmajid A. SARS-CoV-2 infection presenting as colitis with chest and abdomen CT findings

Computed tomography (CT) intestinal alterations of coronavirus disease 2019 (COVID-19) from the imaging perspective: a case description

Abdominal and testicular pain: an atypical presentation of COVID-19

Case report: paralytic ileus: a potential extrapulmonary manifestation of severe COVID-19

Colitis as a sole presentation of SARS-CoV-2 infection: case report. SN Compr

SARS-CoV-2 gastrointestinal infection causing hemorrhagic colitis: implications for detection and transmission of COVID-19 disease

Incidental CT findings in the lungs in COVID-19 patients presenting with abdominal pain

Abdomen CT findings in a COVID-19 patient with intestinal symptoms and possibly false negative RT-PCR before initial discharge

Krauthamer A. Abdominal presentation of COV-ID-19

Abdominal imaging findings in COVID-19: preliminary observations

Three cases of CO-VID-19 disease with colonic manifestations

Bowel necrosis in the setting of COVID-19

Bowel perforation in a COVID-19 patient: case report

Severe colon ischemia in patients with severe coronavirus-19 (COV-ID-19)

Acute abdomen in patients with SARS-CoV-2 infection or co-infection

Spontaneous rectal perforation in a patient with SARS-CoV-2 infection

COVID-19 may present with acute abdominal pain

Pneumatosis intestinalis due to COVID-19 infection in kidney transplant recipient: a case report. Transplant Proc

Abdominal pain: a real challenge in novel COVID-19 infection

Case report: COVID-19 masquerading as an acute surgical abdomen

Gastrointestinal tract imaging findings in confirmed COVID-19 patients: a non-comparative observational study

Coronavirus disease 2019: associated multiple organ damage

Our early experience with mesenteric ischemia in COVID-19 positive patients

Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2

Coronavirus disease 2019 (COVID-19) and ischemic colitis: an under-recognized complication

Superior mesenteric artery thrombosis and acute intestinal ischemia as a consequence of COVID-19 Infection

Poor outcome of intestinal ischemic manifestations of COVID-19

Small bowel ischemia and SARS-CoV-2 infection: an underdiagnosed distinct clinical entity

Arterial mesenteric thrombosis as a complication of SARS-CoV-2 infection

A 29-year-old male construction worker from india who presented with left-sided abdominal pain due to isolated superior mesenteric vein thrombosis associated with SARS-CoV-2 infection

Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COV-ID-19

Kidney infarction in patients with COV-ID-19

Arterial thrombotic complications in COVID-19 patients

Abdominal visceral infarction in 3 patients with COVID-19

Possible radiologic renal signs of COV-ID-19

Acute abdomen -like-presentation associated with SARS-CoV-2 infection

Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19

Inferior mesenteric vein thrombosis and COVID-19

A case report on spontaneous hemoperitoneum in COVID-19 patient

4 cases of aortic thrombosis in patients with COVID-19

COVID-19-related aortic thrombosis: a report of four cases

Abdominal pain in a patient with COVID-19 infection: a case of multiple thromboemboli

Multisystemic infarctions in COVID-19: focus on the spleen

Arterial and venous abdominal thrombosis in a 79-year-old woman with COVID-19 pneumonia

Acute portal vein thrombosis in SARS-CoV-2 infection: a case report

Portal vein thrombosis associated with COVID-19: points to consider

Ovarian vein thrombosis after coronavirus disease (COV-ID-19) infection in a pregnant woman: case report

Visc Med

Acute thrombosis of an aortic prosthetic graft in a patient with severe COVID-19-related pneumonia

Aortitis in COVID-19

Acute pancreatitis in a COVID-19 patient

Acute pancreatitis in a 61-year-old man with COVID-19

ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection

COVID-19 presenting as acute pancreatitis

Pancreatic involvement in SARS-CoV-2: case report and living review

Coronavirus disease-19 (COVID-19) associated with severe acute pancreatitis: case report on three family members

SARS-CoV-2 pandemic: a complicated case of appendicitis

Coronavirus disease-19 (COVID-19) associated with acute umberzing pancreatitis (ANP)

COVID-19 induced acute pancreatitis: a case report and literature review. Cureus

COVID19 induced acute pancreatitis and pancreatic necrosis in a patient with type 2 diabetes. Diabetes Metab Syndr

CO-VID-19 presenting as acute abdominal pain: a case report

Cross-sectional abdominal imaging findings in patients with COVID-19

Recurrent acute pancreatitis in a patient with COVID-19 infection

Acute pancreatitis in a patient with COVID-19

Acute recurrent pancreatitis and CO-VID-19 infection: a case report with literature review. Cureus

SARS-CoV-2 leading to acute pancreatitis: an unusual presentation

SARS-CoV2 RNA detection in a pancreatic pseudocyst sample

Unusual gastrointestinal manifestations of COVID-19: two case reports

A case of adrenal infarction in a patient with COVID 19 infection

Bilateral adrenal hemorrhage in coronavirus disease 2019 patient: a case report

Acute kidney injury due to collapsing glomerulopathy following COVID-19 infection

Testicular pain as an unusual presentation of COVID-19: a brief review of SARS-CoV-2 and the testis

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

COVID-19 can mimic acute cholecystitis and is associated with the presence of viral RNA in the gallbladder wall

Acute acalculous cholecystitis on a COVID-19 patient: a case report

Pseudo-appendicitis in an adolescent with COVID-19

Acalculous acute pancreatitis in a COVID-19 patient

SARS-CoV-2 infection presenting with hematochezia

COVID-19 presenting as severe, persistent abdominal pain and causing late respiratory compromise in a 33-year-old man

Pneumatosis intestinalis in a patient with COVID-19

Pneumatosis intestinalis in COV-ID-19 case series. Cureus

Pneumatosis intestinalis in COVID-19

Pneumatosis intestinalis as an incidental finding in a patient with CO-VID-19 infection

Abdominal gastrointestinal imaging findings on computed tomography in patients with COVID-19 and correlation with clinical outcomes

Features of intestinal disease associated with COVID-related multisystem inflammatory syndrome in children

Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children that is related to coronavirus disease 2019: a single center experience of 44 cases

Imaging findings in multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19)

Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children

Severe SARS-CoV-2 infection in children with suspected acute abdomen: a case series from a tertiary hospital in Spain

Hyperinflammatory shock in children during CO-VID-19 pandemic

Protein losing enteropathy and pneumatosis intestinalis in a child with COVID 19 infection

Intussusception in 2 children with severe acute respiratory syndrome coronavirus-2 infection

COVID-19 presenting as intussusception in infants: a case report with literature review

CO-VID-19 infection is a diagnostic challenge in infants with ileocecal intussusception. Pediatr Emerg Care

Arshad M. Intussusception in an infant as a manifestation of COVID-19

Unusual presentation of CO-VID-19 as intussusception

Intussusception in a child with COV-ID-19 in the USA

Paediatric abdominal pain in the time of COVID-19: a new diagnostic dilemma

Pancreatitis in pediatric patients with COV-ID-19

Orchiepididymitis in a boy with COVID-19

Necrotizing enterocolitis-like pneumatosis intestinalis in an infant with COVID-19. Pediatr

Assessing ACE2 expression patterns in lung tissues in the pathogenesis of CO-VID-19

Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with coronavirus disease 2019: a systematic review and meta-analysis

Acute respiratory tract infection leads to procoagulant changes in human subjects

Critically ill COVID-19 infected patients exhibit increased clot waveform analysis parameters consistent with hypercoagulability

Gastrointestinal complications in critically ill patients with and without COVID-19